Are doctors really making between $60 to $130 per hour?

In the setting of national health care reform, we're looking for every possible way to cut costs. Should medical specialists make less? Should primary care physicians make more? Does it make sense to bridge the income gap? According to this recent paper in the Archives of Internal Medicine by Leigh et al, "Wages varied substantially across physician specialties and were lowest for primary care specialties."  On MSNBC, you'll find a Reuters article titled, "Do specialist doctors make too much money?"

It's one thing to look at annual salary. When you combine that information with the average number of hours worked per week or month, you get a different perspective on these specialties. The reality is that some primary care physicians can earn a high salary if they're willing to work many hours. The average specialist can work fewer hours and still make more. If we increase the salary to primary care physicians, this won't improve the fact that our nation is spending so much money on health care, will it?

If we're reforming our national health care system to look more like the health systems found in other countries, we'll need many more primary care providers and fewer specialists. This won't be popular to our "consumerism" mentality given that so many patients demand to be seen by a specialist (even when they don't need that level of care).

Leigh JP, Tancredi D, Jerant A, Kravitz RL. Physician wages across specialties: informing the physician reimbursement debate. Arch Intern Med. 2010 Oct 25;170(19):1728-34.

Another potential way to reduce breast cancer risk: breast feeding

"Breast-feeding may protect at-risk women from breast cancer"

CNN STORY HIGHLIGHTS:

• Study: Nursing cut the risk of breast cancer in half for high-risk women
• Researchers followed 60,075 women for more than nine years
• Breast-feeding's effect was similar to taking tamoxifen for five years
• Breast-feeding didn't affect risk for women who didn't have breast cancer in family

We all probably know someone who has been affected by breast cancer. Fortunately, treatment is quite effective if the cancer is diagnosed and treated.

This new research sounds quite promising, but we probably still don't have enough evidence to make any claims about causality. We know that there is an association, but that's about it because this was a prospective cohort study. I don't think we're ever going to see any randomized controlled trials evaluating this clinical question, so this may be the best type of evidence we get.

Click here for the story on CNN.
Click here for the abstract from the Archives of Internal Medicine.

Reporting abnormal test results to patients

There's an article in the Archives of Internal Medicine titled, "Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results." Lead author Lawrence P. Casalino, MD, PhD is from the Department of Public Health, Weill Cornell Medical College, New York. In this study, failures to inform patients of clinically significant abnormal test results or to document that they have been informed appear to be relatively common, occurring in 1 of every 14 tests.

Here's what was most interesting to me: Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007).

Was this study flawed? After all, they used medical students to perform chart reviews. Did the researchers make a mistake when they collected or analyzed the data? Is it possible that physicians have become too dependent on the use of electronic health record (EHR)?

You can view the entire article here.

Sleep Habits and Susceptibility to the Common Cold

The Archives of Internal Medicine has an article titled, "Sleep Habits and Susceptibility to the Common Cold." This study found that "Poorer sleep efficiency and shorter sleep duration in the weeks preceding exposure to a rhinovirus were associated with lower resistance to illness."

This study evaluated 153 healthy adults who volunteered to let this happen to them: "participants were quarantined, administered nasal drops containing a rhinovirus, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 days after exposure." I wonder how many of those 153 adults were medical students. When I was in medical school, some of my colleagues were volunteering themselves for studies that involved biopsies of their leg muscles. Medical students will volunteer for anything, won't they!

Rhinovirus causes the common cold, but I wonder what this reflects about our immune system's response to other viruses like influenza and swine flu.